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Another Biopsy?

Posts: 2
Joined: Dec 2015

 Gleason 6 Aug 2014, chose watchful surveillance ,  Had MRI of prostate in Nov 2014---no cancer seen.

MRI of prostate in Nov 2015,  2 urologist's state they can see the tumor ( in same area the gleason picked it up on biopsies, Left side).  They both  told me this has grown rapidly in 1 year, and recommend surgery or radiation. If I do anything it will be surgery.
One urologist told me he would bet, based on the MRI, I am now a Gleason 7 or 8.
They don't think it has escaped the capsule.

Question: Would you get another Biopsy just to confirm the gleason has gone up, beyond a 6?

I would be quite pissed if I have this taken out and the pathology report says it's still a gleason 6.

hopeful and opt...
Posts: 2338
Joined: Apr 2009


As a man who has been in an Active Surveillance(AS) program for almost seven years now, I hope that I can provide input that you will find useful.

First , if you wish you can click my name on the left to see the monitoring that I done,  information about AS in general, and information about some pertinent tests.


The biopsy is the critical informaton for any treatment, if necessary.

The multiparametric MRI (T3 magnet is the best in clinical practice) indicates tumors which may or may not be cancerous. The MRI is not the critical test for treatment. The MRI gives a very good indication if the cancer is outside the capsule.


This is important:

Where I am being monitored, and a few other institutions at centers of excellence, a multiparametric MRI T3 is first done, where suspicious tumors are determined and ranked from 1 to 5 with the potential of the possibliity of being cancerous....then the MRI results are locked into a three dimensional biopsy machine (different from the two dimensional biopsy machinefound  in the average urologist office), that is able to pinpoint each of these tumors, and samples are taken..............(so a sample is taken of each of these suspicious tumors in a biopsy) ...which gives more confidence in the results, and a urologist does not have to "bet" as in your case.


So we can provide better answers for you, Nash, please let us know the number of cores that were taken, the number that were cancerous, and if you know, the involvement of each core that was cancerous, that is the percent involvement in each core.

Also please let us know your PSA history.

What did the DRE (finger wave) show?

What is the size of your prostate?...should be on the MRI report.

What is your age?

What area of the country do you live in?





VascodaGama's picture
Posts: 3427
Joined: Nov 2010


I read your two threads and think that you are concerned with erection dysfunction (ED) due to surgery. The truth is that neither pumps or injections or pills or penile mechanisms/repairs, can substitute our natural ways in getting erections for sex enjoyment. Nerve spare techniques in surgeries also do not assure an erection quality in similar levels of a natural process. It also affects the possibility in fathering a child.

You have not share details of your PCa case (diagnosis, clinical stage, etc.) but if your status allows avoiding messing with the nerves, then I would choose a treatment with radiation (not Brackytherapy) that could manage to tackle both aspects; treat the cancer and avoid the dysfunction.

Hopeful above is suggesting the best way to judge a treatment starting with AS. Surgery or radiation would follow as the radicals most proper to assure cure, statistically at the same level; however, their risks and side effects differ in levels. In this respect I wonder why you have chosen surgery.
The MRI image can identify protuberances but such finding does not mean that it is only related to cancer. It could be calcifications which could increase significantly in one year. I am not a doctor but, sincerely I question your physician assertion that the Gleason score has increased from 6 to 7 or 8, simply based on the latest MRI exam. Moreover, if your cancer is so aggressive that “modified” its grade and increased its volume in a space of one year then surgery may not be the recommendable way to treat your case because you risk recurrence, and if recurrence post surgery becomes a probability then the concern with ED becomes more evident after two “sets” of therapies; RP plus SRT.

In the “pump” thread you commented having scheduled surgery to be done in one month. In any case I think you should get a second opinion before deciding. If you have not done so already, you could consult another specialist bringing along all the information at your hands and get an opinion on treatments that better address your concerns. You can always reschedule a PCa treatment but cannot replace a dissected gland.
I recommend you to rethink about your case and discuss it with your family before any decisions.

Regarding your question on the pump, my experience is that it works but one looses that “interest” if it takes too long to get “ready”. After surgery the penis becomes about one inch shorter, and the genital hair around the penis also disturbs proper fixing of the pump.
The injection seems to be easier for the accomplishment but this is for those that manage to inject each time a needle it his penis. Pills are simple but some do not work as well as others and take much longer to get into the pole position. Your partner may not want to wait that long.

I suggest that you get more educated on matters of PCa, risks of treatments and the side effects.

Best wishes and luck.


Max Former Hodg...
Posts: 3705
Joined: May 2012


I had not noticed this thread when I responded to your ED thread. Let me say here that I agree with everything Vasco wrote regarding taking your time and investigating the best therapy for you to proceed with.  I met with three doctors before making my own decision: the urologist (who is a surgeon), a radiation oncologist, and a phone consultation with my medical oncologist (who I knew from my lymphoma treatment). Hopeful is a wonderful writer here with his encyclopedic knowledge of A.S.

Post-surgical sex, while it can be good, will never be like pre-surgical experience. Regarding radiation, I have no experience.

Staging PCa is trickier than most other forms of cancer -- harder to see on most available scanning devices.   I would not recommend a second biopsy simply because they are so inexact, and you already know from the imaging that the tumor has enlarged (i.e., it is on the move).

I was staged by my biopsy at t1a. When the gland was cut out the next month, it was actually t2a, as determined by the post-operative pathology analysis. It is not uncommon for biopsies to underestimate the extent of PCa.  Overestimating is much, much less common.

As Vasco stated, you owe it to yourself to at least meet with a radiation oncologst.


Posts: 1013
Joined: Mar 2010

While biopsies have their risks, there really is no other alternative for diagnosing PCa.   So, if it's been over a year, I'd get another biopsy to get clear picture of where you stand now and then make a further treatment deicsion based on this info.

FWIW, I do think there is ever a good reason to choose surgery for the treatment of PCa because of the risk of ED, incontinence, infection and "mistakes" associated with it.  If you are still a Gleason 6 or 7 and the cancer is still confined to the prostate capsule, I'd highly recommend you consider CyberKnife (or even IMRT) before surgery but, of course, that's your decision.

However, you still need accurate info on which to base a treatment decision and another biopsy would better prepare you to make that decision based on your current circumstances.  Good luck!


Posts: 25
Joined: Jan 2016

I had the same question

Since the pathologist already has a sample of the  cancer tissue I then ask for another pathologist to look at the tissue 

and reconfirm if it's a gleason 8 or not. ( and Gleason 8 is what I have )  i asked the urologist to recheck using another pathologist and 

the findings were same.

Thereafter I met with the oncologist and decided to go hormones brachytherapy and radiation.  Or the combination program.

is that the right decision ?  Is surgery better ?  There is no clear answer.  And ,

while the cancer is currently confined to my prostate , and would surgery be then end of this problem?  There is no answer.

So I chose then combo program.


So I asked the oncologist when would he know that he cured the cancer.  hr said 

" Well if youre alive in 10 years then its cured.  If not then it was not".

i fell over laughing.  It was simple truth.



VascodaGama's picture
Posts: 3427
Joined: Nov 2010


I read your other posts. The Flomax issue should be carried out as per recommendation of your doctor even if the flow is somehow feasible. Regarding the Bracky procedure it may have been the best choice. I hope that your doctor is correct. Your marker of treatment success will be periodic PSA test; however these will be influenced by the adjuvant period of ADT (hormonal treatment) effects, masking it to lower values. In any case these should create a curve, increasing during the first two months and then declining to a nadir that could take two years to reach.

Your gym work will help in controlling the effects of the Lupron. You may look for a change in diets and life style.

Best wishes for a successful outcome.


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